不经伤椎椎弓根长节段CD内固定治疗胸腰椎爆裂骨折

Long segment CD internal fixation without a pair of pedicle screws in fractured vertebra for treating thoracolumbar burst fracture

目的观察不经伤椎椎弓根长节段CD内固定治疗胸腰椎爆裂骨折的临床疗效。方法对2006年7月至2011年7月收治的65例胸腰椎爆裂骨折利用不经伤椎椎弓根长节段CD内固定治疗,术后观察神经功能恢复情况、骨折椎体前缘压缩率变化、后凸角变化及并发症。结果随访43例,随访时间8～24个月,平均(14±5)个月。神经功能按Frankel分级:术前C级7例,D级14例,E级22例;术后C级2例,D级6例,F级35例。椎体前缘压缩率由术前(39.8±5.8)%恢复至术后7 d(91.7±4.2)%,末次随访(86.8±2.5)%,局部后凸角由术前(24.7±1.8)度恢复至术后7 d(1.7±0.8)度,末次随访(2.4±0.5)度,术前与术后7 d伤椎前缘压缩率、矢状面脊柱后凸角比较差异有统计学意义(P<0.05),术前与末次随访比较差异有统计学意义(P<0.05),术后7 d与末次随访比较差异无统计学意义(P>0.05)。术后患者均未出现迟发神经损伤,无钉棒断裂或松动,无明显疼痛、感染等并发症。结论不经伤椎椎弓根长节段CD内固定治疗胸腰椎爆裂骨折可获得满意疗效。

Objective To observe the clinical efficacy of long segment CD internal fixation without a pair of pedicle screws in the fractured vertebra in treating thoracolumbar burst tYacture. Methods From July 2006 to July 2011,65 cases of thoraeolumbar fracture were treated by long segment CD internal fixation without a pair of pedicle screws in the fractured vertebra. After operation, the improved nerve tunction, the change of anterior fractured body height compression rate and regional kyphosis angle and complication were observed. Results 43 cases were followed up for 6-24 months[average （ 14±5 ）months] after operation. According to Franke＇s neurological function classification, the preoperative neurological function was grade C in 7 cases, D in 14 cases and E in 22 cases;the postoperative neurological function was grade C in 2 cases, D in 6 cases and E in 35cases. The anterior fractured body height compression rate were recovered from preoperative （39.8±5.8）% to （91.7±4.2）% on postoperative 7 d and （86.8±2.5） % in last follow up .The regional kyphosis angle were recovered from preoperative （24.7 ± 1.8） o to （ 1.7 ±0.8） ° and last follow up （2.4±0.5）° on postoperative 7 d,showing statistical difference between preoperative group and postoperative 7 d group （P〈0.05）and between preoperative group and last follow up group （P〈0.05）, but there was no statistical difference between postoperative 7 d group and last follow up group （P〉0.05）.There no delayed nerve damage, no loosening or breaking of screws and rods, no obviously pain, no infection and other complications. Conclusion Long segment CD internal fixation without a pair of pedicle screws in the fractured vertebra has the satisfactory effective in the treatment of thoracolumbar burst fracture.